Michael Bader

It Will Take a Political Revolution to Cure the Epidemic of Depression

What causes depression and anxiety? I have been a practicing psychologist and psychoanalyst for almost 40 years and have seen hundreds of patients suffering from both. In my experience, some factors are obvious. People who suffer from depression and anxiety have experienced stresses and traumas in their development that predispose them to mood disorders. Garden-variety psychodynamic theory teaches us that issues involving loss, neglect, guilt, and rejection usually figure prominently in the backgrounds of people who present with significant symptoms of depression and anxiety.

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Going to the Heart of the Matter: Peter Gabel Argues for a Psycho-Spiritual Politics

"A human being is a part of a whole…but he experiences himself, his thoughts and feelings as something separated from the rest, a kind of optical delusion of his consciousness." —Albert Einstein

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Bruce Springsteen's Broadway Show Is Gripping

Imagine that Bruce Springsteen came to your home, sat in your living room, and told you the story of his life while serenading you with some of his most beautiful songs. That’s what it felt like at his show, Springsteen on Broadway, currently in the middle of a four-month run at the Walter Kerr Theater in New York City. For two hours, on a stage stripped bare except for some roadie crates and boxes, a brick backdrop, a single microphone stand for the Boss and his guitar, and a piano, Springsteen delivers a one-man show consisting of autobiographical stories interspersed thematically with 15 songs. It’s not a concert, and yet Springsteen’s musicality and voice—amplified in warm and full tones by Tony Award-winning sound designer Brian Ronan’s sound system—is on full display. It’s not a play, and yet Springsteen’s lines are completely scripted, often read from a teleprompter. It’s a third thing, a performance of a life story set to music.

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You Don't Need to Be a Shrink To Understand Trump's Mind

Everybody knows that Donald Trump is mentally disturbed. His mental illness is hiding in plain sight. Someone who can never admit a mistake or show remorse or guilt is unbalanced. Someone who frequently brags and demeans others is emotionally insecure and volatile. And someone who appears to lack empathy invariably has something missing inside. No one has to go out on a limb to know that these things are true.

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Pass the Salt: The Myth of the Low-Salt Diet

Pass the salt. Eat a pickle! Add more anchovies to your salad! According to a new book by James DiNicolantonio, you can freely consume salt without worrying about your blood pressure and heart. In fact, too little salt can endanger your health.

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Psychoanalyzing Donald Trump

I’m going to psychoanalyze Donald Trump. In doing so, I may seem to be violating the “Goldwater Rule,” that enjoins psychotherapists from diagnosing public figures based on secondhand information. However, I happen to agree with the consensus of a recent conference of mental health professionals at Yale University that argued mental health professionals have a “duty to warn” people about the danger posed by Trump’s mental illness. 

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How Sugar Became the Great Public Health Hazard of Our Time

It’s no news flash that corporations make money selling products that turn out to be harmful to public health, or that these corporations not only oppose government regulation but support biased scientific research that creates confusion about the harm their products are causing. The story is often the same: A company knew its product caused harm; it covered up the truth, and promoted false science in its own defense.

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The Breakdown of Empathy and the Political Right in America

In 1978, developmental psychologist Edward Tronick and his colleagues published a paper in the Journal of the American Academy of Child Psychiatry that demonstrated the psychological importance of the earliest interactions between mothers and babies. The interactions of interest involved the playful, animated and reciprocal mirroring of each other’s facial expressions. Tronick’s experimental design was simple: A mother was asked to play naturally with her 6-month-old infant. The mother was instructed to suddenly make her facial expression flat and neutral; to remain completely still, for three minutes, regardless of her baby’s activity. Mothers were then told to resume normal play. The design came to be called the “still face paradigm.”

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Springsteen's Astounding Candor: Born to Tell the Truth

One Saturday afternoon in the early 1980s, I was home visiting my mother who lived in a small two-bedroom apartment in the wealthy community of Rumson, New Jersey. I was in my early 30s. I was walking down Bellevue Avenue, admiring the gorgeous and stately homes partially hidden behind walls and high hedges, and as I reached Ridge Road, I stopped in front of one of these mansions. I knew it belonged to my high school musical hero, Bruce Springsteen. No, unlike what Springsteen admits doing at Graceland, I did not climb the wall and try to meet my hero. I just remember looking with a longing, a nostalgic ache, desiring something I couldn’t articulate. I guess I wished I could go inside, see Bruce in his “natural state,” hang out, get close to him, or be a fly on the wall, observing what mattered to him.  

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Is Universal Basic Income a Powerful Strategy Against Job-Killing Automation? Andy Stern Thinks So

During his 15 years as president of the Service Employees International Union, Andy Stern was a controversial figure. He suffered his share of criticism from inside and outside the union. There was, however, no disputing his success in making SEIU the largest and fastest growing union in the country and a powerful political machine that was instrumental in electing President Obama and getting the Affordable Care Act passed.

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Trump, Sanders and the Longing for Authenticity

There is a saying that, in the land of the blind, the one-eyed man is king. In the political sphere, we are all so used to canned speeches, talking points and stage-managed and inauthentic personalities that when someone like Donald Trump comes along, his offensive speech passes for authenticity. Similarly, Bernie Sanders’ down-to-earth rhetoric and wildly gesticulating arm gestures also suggest that he is being real, and as a result, breaks through the mind-numbing conformity of today’s political discourse.

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Paul Krugman Is Not Making Much Sense

Paul Krugman has been a voice in the wilderness for liberals for decades.  But his piece in the Times about Bernie Sanders’ lack of policy credentials and Sanders’ “petulant self-righteous” followers misses the boat completely. 

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Let's Ditch the Media and Establishment's Cynicism and Go After What We Need and Want

As a psychotherapist, I try to help people overcome the beliefs that cause them distress and inhibit them in life; beliefs about themselves and the world (usually acquired in childhood) that are unconscious but highly pathogenic. For example, some patients have the belief that they’re not supposed to have more of the good things in life than their parents had, or that they don’t deserve to be loved, or that they’re not supposed to be ambitious and successful. These beliefs are hard to change because they don’t feel like voluntary beliefs that are under the patient’s control. Instead, they feel like they are simply the way things are and the way they’re supposed to be. To believe otherwise is to risk the pain of rejection, shame or failure.

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It Is Paul Krugman Who Lives in a Fantasy World, Not Bernie Supporters

Nobel Laureate Paul Krugman can’t stand that people are irrational; that working-class conservatives are duped into voting against their own economic interests. In a recent New York Times editorial called "How Change Happens," Krugman complained that liberal Bernie Sanders supporters are hopelessly waiting for the “better angels” in people to rise up and radically change our corrupt institutions. Real change, he argues, requires rational pragmatism and compromise.

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How Can We Stop America's Deadly Epidemic of Loneliness?

We are all so much together, but we are all dying of loneliness. —Albert Schweitzer

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A Psychologist Puts Trump and the GOP on the Couch

Rather than simply reacting with self-righteous contempt for the current crop of GOP presidential candidates, liberals like myself should try to also understand their appeal, however much we might believe it’s not strong enough to put any of them in the White House. The pre-scripted kabuki dances on display in their debates have made them easy targets for disdain, so easy that it’s a bit like playing Pin the Tail on the Donkey with your eyes open. Trump is an obviously racist bloviator, the creepiest and most blatantly disturbed of the bunch, for sure, but the lot of them come across as empty suits projecting poll-driven personas that their handlers believe will resonate with their base of angry and/or older white men. Moments of “authenticity” (e.g., they love their parents, spouses and children—imagine that!) are, themselves, always wooden, overly-crafted and ginned up with phony emotion and reported breathlessly by a media itself unable to stand on its own two feet and tell truth from fiction when it comes from these conservative wind-up dolls.

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Why Some People Act in Mean and Offensive Ways Toward Immigrant Children

The hate and fear directed at immigrant children today is mean and offensive. There are a lot good people who agree with me, but they aren’t organized and don’t get much media attention. Progressives and people committed to compassion in public policy should fight for open borders and provide sanctuary and protection for the victims of persecution and poverty who come to the United States

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The Surprising Reason Americans Might Feel Helpless and Depressed

We are a nation on hold. We wait endlessly for everything. Some of us are forced to wait in physical lines, but increasingly these queues are electronic or digital. We can’t get answers to our questions or obtain help with important problems from the huge corporate entities that sell us insurance, mortgages, medications, airline tickets, computer hardware and software, phone and cable service, and even direct medical care. The toxic result of this increasingly intolerable system of phone queues, Muzak, and long waits is helplessness. But like the frog that doesn’t know it’s being cooked because the temperature of the water rises slowly, these particular feelings of helplessness have become so ubiquitous that they seem normal. Waiting just seems like the way the world is and the way it’s supposed to be.

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9 Blind Spots Most Therapists Share

Does your therapist have a blind spot? Every therapist has to have a theory that guides his or her work. We can’t function without one. The problem with theories is that they can often obscure what people need rather than clarify it. Theories that are held too strongly create blind spots.

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Go Deep, Not Thin, to Win

In the 30 years I have worked as a therapist, I have had intense conversations with CEOs, union leaders, academics, business owners, housewives, geeks and non-geeks, baristas, consultants and unemployed, young and old people, Latinos, African Americans, Asians, and whites; the very wealthy, middle-class, poor, and destitute. I have tried to help, and have helped, thousands of people.

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Bruce Springsteen and the Politics of Meaning in America

Others have written about the complicated ways that Bruce Springsteen weaves together the personal and the political and how this interweaving has developed over time.  I’ll mention some of these themes but won’t spend a lot of time exploring or illustrating them:
1)  First and foremost, the healing and transcendent power of love and community.  This is, perhaps, one of the most central concerns of his life.  His songs are full of it.  The ecstatic sense of abandon, fusion and joy at his concerts feature it.  Wrecking Ball is a good example of this.
2)  Mutual recognition and embrace of the Other: Springsteen’s songs are full of images of people making the choice to—in the end—see their commonality rather than their difference.  The Ghost of Tom Joad is full of stories like this.
3)  Confronting the survivor guilt facing his generation as they became parents and achieved economic security and success.  Perhaps the best line in all of Springsteen’s music about this is from Lucky Town where he complains that “it’s a sad funny ending, when you find yourself pretending, a rich man in a poor man’s shirt.”

4)  The insistent search for meaning and purpose in the face of alienation, loneliness, and the mundane repetitive rhythms of everyday life, whether that be through leaving home, rock-and-roll, love, or the redemptive courage shown in a song like “Into the Fire” in The Rising.

5)  Outrage at the breakdown of our society’s social safety net and promise of collective responsibility along with a call to not only restore it but relentlessly offering up example after example of small acts in which this is manifested.
Each of these themes could be elaborated in great detail.  I'm not going to focus here, however.
[SIDE NOTE:  I wish I could say that these themes were what first drew me to Springsteen, but I can’t.  I first heard him when he was with Steel Mill.  He played at my senior prom, after which I was mostly looking forward to getting high and playing around with my girlfriend!]
There is an old adage is that there are two sources of political power:  organized money and organized people.  The Right has almost unlimited oceans of money and organization.  The Progressive Movement needs to organize people in numbers far far greater than we’ve done to date. 
I’m going to argue this:  That in order to organize and engage the masses of people we need, progressives have to expand their notions of what makes people tick, of what they need, of what they value and long for----from a simplistic liberal emphasis on economic justice and equity to a broader view of human needs that include needs for recognition, meaning, connectedness, and agency.
Bruce Springsteen’s music and his performances do just that.  They suggest the possibility of a relationship with oneself, with others, and with the social world that elicit and cherish just these kinds of values and needs in his audience.
So, even though Springsteen can often sound like he’s offering a traditional liberal critique of
class and the maldistribution of income and wealth, I think he’s doing much more.  I think he’s one of few musicians today articulating a politics of meaning which I will argue is the only approach that progressives can take in our current climate that has a snowball’s chance in hell of winning. 
And it’s an approach missing everywhere in our movement.
So, what is this predicament and why can’t old style liberal democratic politics compete any more?
I wear two hats.  I’m a psychoanalyst with over 30 years clinical experience.  But for the last 10 years I’ve been part of an interdisciplinary group called the Institute for Change.  We already do or soon will work with some of the most powerful leaders and organizations in the progressive movement today, including labor unions, progressive fundraising groups and infrastructure groups that provide much of the “intelligence,” data, and strategy that contribute to shaping our movement's direction.
The progressive movement, including the Democratic Party is on the run everywhere.  Unleashed by the Citizens United Court decision, an unlimited tsunami of money is flooding political contests at every level, not just the national election. 
In addition, the current Great Recession, and the unchecked greed that both caused and resulted from it, have revealed, not just created, fractures and weaknesses and suffering that have been going on for a long time now.
My view is that the non-economic suffering, now extreme, has been every bit as profound as the economic suffering, except that so much of the non-economic suffering exacerbates the feelings of self-blame, cynicism, anxiety, and resignation that makes it even harder for progressives to engage people.
The loss of a job or insecurities about such a loss reverberate through marriages and families.  The suffering is not just material, but psychological and relational.  Such losses and threats create high levels of anxiety and stress, depression and self-doubt.  People blame themselves.  This is what Springsteen sings about so often.  They lose their tempers more often, retreat from social contact, suffer from increasing amounts of insomnia, drug and alcohol use and abuse.  Their health deteriorates.  And for every person directly affected, there are many others in relationship to this person affected as well.
Relationships are strained as homes go under water.  This is the first time in history that parents can’t expect that their kids will do better than them.  Optimism and joy become harder to come by.  Think about the unintended neglect caused by mothers having to shorten maternity leaves or parents leaving their kids to hold down 2 or 3 jobs.  And, in fact, studies show that young people are increasingly distrustful of others, depressed, and “lost.”
We still live within the myth that this is a meritocracy, that one’s mobility and success is a sign of one’s value and ability.  During economic slowdowns, people’s sense of agency becomes shot through with depressive resignation, a combination of self-blame and helplessness that is toxic.  And who writes about this better than Bruce?
In other words, the suffering in America today is not simply material or economic.  It involves the frustration of other needs as well, including needs for meaning, for recognition, for connectedness or community, and for agency. These other needs are every bit as important and their frustration causes every bit as much suffering.
When recessions like this one stimulate and accentuate these forms of suffering, there are few institutions on the Left that are available or capable of addressing them.  Unions are shrinking or on the run.  The Church has increasingly exited public life, except for conservative ones.
And liberals are still fixated on the mistaken notion that economic welfare alone as the only dimension of human life that can motivate people to connect with a movement.
We—progressives—talk about the availability of jobs, not community, not the quality of work, the mind-numbing alienation that such jobs are often infected by.  One of the best lines at the Democratic Convention was when Joe Biden said that “a job is about more than a paycheck; it’s about dignity.”  Springsteen is constantly talking about the distance between the crushing blow of losing a job or its degradation and the ideal.
We talk about access to quality health care, but don’t really emphasize problems that affect people who DO have health insurance, things like wait times, and inaccessible doctors and, most of all, the almost complete breakdown of the doctor-patient relationship.
There’s a void in our politics that can’t be filled by the outrage of people pissed off at banks and a lack of fairness.  In 2000, the sociologist Robert Putnam wrote a book called “Bowling Alone” in which he demonstrated the degree to which community has broken down in America, fraternal, collective, community based organizations that used to provide social support.
Working with Labor Unions, I’ve seen over and over again, that the assumption of their leaders and staff is always that the only thing their members care about is protection and money and, thus, their interactions with members are usually limited to solving problems and negotiating contracts rather than what community organizers have known for years---that people hunger for relationships, for recognition, opportunities to learn and make a contribution. 
This is something that the leaders of the civil rights movement understood, but that we’ve forgotten.
I’d argue that, whether or not he is always conscious of it, Bruce Springsteen has not forgotten.
During the 1992 campaign, soon after her father died, Hillary Clinton gave a speech in which she said something like this:  “The ‘market’ knows the price of everything but the value of nothing.  We need a politics of meaning in America.”

She was a reader of Tikkun Magazine whose editor, Rabbi Michael Lerner, had been arguing for years that the Left, progressives, and liberals had let the Right represent itself as the ones who stood for community, for religion, for family, for the values of work and safety.

As opposed to our movement which talks almost exclusively about rights and money and the safety net and jobs.
Springsteen talks about mainstream liberal issues, too.  These traditional liberal democratic themes are ubiquitous in his music.  But I’d argue that it’s because he also address these other, non-economic needs, that his appeal is not limited to liberals or the Left.  He’s not, for example, in this one sense, like my second favorite singer/songwriter—Steve Earle.
Springsteen speaks—in his music and in his concerts in particular—to the usually unarticulated needs for meaning, connectedness, and mutual recognition that we all have, but that—in our culture—rarely are allowed to take center stage.  For progressives, this is especially important, because the almost universal response to his songs, the way that both the content and the form of their presentation “calls” us to a higher purpose, connects us to each other, and offers us a place in a bigger story, is powerful evidence that these needs ought to ALSO be central in our political work. 
That is, if we want to connect to people, engage masses of people in our movement, then we better figure out a way of speaking to people at all of the multiple levels that Springsteen does.
That’s why conservatives can like Springsteen—at least his concerts—I think.  That’s why David Brooks can follow him around Europe, even though he then writes a nonsense column to explain Springsteen’s appeal.  It’s because Brooks, himself, like many Americans, never has much of an experience of being part of something bigger than himself.  There’s nothing ordinarily for him to “get on-board.”
Springsteen intentionally creates an ecstatic community in his concerts, and it’s a loving one.  It speaks to the hunger we have to such an experience.
His songs are often about recognition, about being part of something bigger than the self, and about having the power to make choices, even if these choices go against conventional norms. 
I don’t believe that a singer or songwriter can change someone’s mind about fundamental ideological choices.  I do, however, think that he or she can capture the leading edge of emerging shifts in consciousness and that his or her popularity can help us understand feelings and longings that are typically not expressed or satisfied in everyday life.
And in Bruce Springsteen’s case, I think that his phenomenal popularity results from the ways he touches our unmet needs for community, meaning and purpose, and recognition.
I would call this a Politics of Meaning and I think it is the only approach progressives can take to our present predicament that has a snowball’s chance in hell of winning.
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How We Can Inspire People to Care About Social Change and Feel Good About Themselves in the Process

If the Wisconsin struggle between the unions and Governor Walker showed us anything, it was that the needs that animate people around progressive causes are not simply needs for money or financial security. The need for community and its accompanying feeling of belonging and the need to connect with something larger than the self, the need for meaning, were every bit as important in generating the special enthusiasm and emotional engagement seen for weeks in and around the state capitol in Madison.

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Why We Need to Have Empathy for Tea Party Lunatics

These Tea Party folks seem to most liberals -- well, to most of us who live in the "reality community," or, as I like to call it, "reality" --- like crazy fuckers.

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The Soul-Crushing Malaise of the 1950s Killed the American Dream

My parents have been dead for years, but Hollywood has recently resurrected them. Last week I saw the new film "Revolutionary Road" and then came home and watched reruns of the television show "Mad Men." I confess that I was a little freaked out finally to see an accurate portrayal of my 1950s baby boomer childhood, one that was neither "Father Knows Best" nor "The Twilight Zone". Leonardo DiCaprio's character, Frank Wheeler, and Jon Hamm's Don Draper are so much like my father that it hurts to watch them. Like my father, each live lives of quiet desperation as upwardly mobile white-collar executives commuting to unsatisfying jobs in which they've traded passion for privilege. And, like my father, each left behind wives vainly struggling to find meaning in domesticity. Although Mrs. Wheeler (Kate Winslett) self-destructs and Mrs. Draper (January Jones) files for divorce, while my mother merely became bitter and depressed, all three struggled with the combination of emptiness and isolation that Betty Friedan called "the problem with no name." Seeing it depicted so perfectly was unsettling.

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Thought Crimes

When Bob Dylan wrote, "If my thought-dreams could be seen, they'd put my head in a guillotine," he was expressing a distinction that our culture seems increasingly to blur; namely, that thoughts are not the same as actions, that fantasies are not the same as reality. The Supreme Court's recent ruling that the Child Pornography Prevention Act of 1996 unconstitutionally abridged free speech implicitly reaffirmed these distinctions.

Child pornography was made illegal originally to protect the actual children used in its production. In 1996, however, Congress expanded the definition of child pornography to include computer-generated images -- images not of real children but of virtual ones. The ostensible rationale of the bill was that virtual pornography was used by pedophiles to entrap real children and that the viewing of virtual pornography would stimulate the appetites of would-be pedophiles and increase the likelihood that they would then act out their impulses. The Supreme Court correctly rejected this argument, citing the absence of any credible evidence supporting these claims.

As Justice Anthony M. Kennedy pointed out, if we're no longer simply criminalizing the damage done to real children in the production of sexual images, but also the damage potentially done to them by exciting the impulses of the consumers of these images, then thoughts themselves become the crime. Following that logic, a filmmaker who uses an adult woman to portray a 16-year-old girl in sexual situations (as in the film "American Beauty") is potentially harming children, not on the movie set but in the minds of the film's viewers.

Such a position not only threatens free speech and artistic expression, but it contradicts what we know about human psychology. The problem lies in its failure to differentiate between private experience and public behavior, between fantasy and reality.

Every single day the patients in my psychotherapy practice tell me about thoughts and fantasies that are packed with powerful emotions, from rage and sadness to exuberance and sexual excitement. One patient gets so angry with his father that he imagines taking a shotgun and blowing his father's brains out; another has an exciting sexual fantasy about her next-door neighbor; and still another surfs the Web collecting pornographic images of teenage girls. None of these people has any intention of acting on their impulses.

While fantasies do not predict behavior, they do serve important purposes. The homicidal fantasy of the first patient, for example, expressed his fear and helplessness vis-à-vis his real father. Unable to stand up to him in real life, the patient did so in a dramatic way in his daydreams. The second patient used her sexual fantasy about her neighbor to momentarily escape from a deadening marriage. And the patient who pursued his Lolita fantasies on the Web was desperately trying to ward off feelings of depression. Fantasies are not usually rehearsals for action. Often, in fact, they're substitutes.

Clinical experiences like these are not extraordinary. But they shine an especially bright light on the meaning of sexual fantasies, and they belie the argument that fantasies expressed on the Internet lead to dangerous actions. Such fantasies may be pathological in many ways and may even significantly impair an individual's relationships and life satisfactions, but they are simply not usually a prelude to action.

The pedophilic fantasies portrayed on the Internet offend many people because we know that real children are hurt by the sexual predations of adults, an awareness that has grown in our society as a result of victims speaking out -- witness the current revelations about the Catholic Church.

Fantasies about hurtful actions, however, don't necessarily hurt anyone. Such fantasies may disgust or provoke us, but that isn't sufficient reason to outlaw them. For every instance of bizarre sexual behavior there are a million instances of bizarre sexual thoughts. For every case of actual pedophilia, there are thousands of people, mostly men, with pedophilic fantasies. While it might be true that the sexual abuse of children begins with a fantasy, the reverse is not the case.

Human beings use fantasies to express forbidden feelings and wishes, to master and overcome inhibitions and to creatively find comfort in a private arena that isn't subject to public judgment or sanction. We should put our efforts into apprehending, punishing or treating those people who are hurting children in practice, not in their imaginations.

Michael Bader is a psychologist and author of "Arousal: The Secret Logic of Sexual Fantasies."

Embracing Post-Traumatic Sex

We've been hearing a lot lately about so-called "terror sex" or "end-of-the-world" sex, a phenomenon in which some Americans are reportedly now feeling an increased sex drive in the wake of the Sept. 11 terrorist attacks. Following this country's recent catastrophe, the story goes, strangers are reconnecting with a renewed sexual intensity. Reporters, for their part, are alternately speculating that "terror sex" is an attempt to triumph over death, or that we have a biologically programmed human need to propagate the species in the face of threats to our survival, or that fear and arousal are somehow intrinsically linked, or that sex is simply the means by which we re-establish meaning in the face of the unknown.

Of course, the problem with these explanations is that they don't fit with the clinical experience of a psychologist such as myself at all. In the 20 years that I've been practicing psychotherapy and psychoanalysis, I've treated many people who have lived through catastrophes, from survivors of violent crimes, to earthquake survivors, to people who have fled from terrorism in their homelands. On the occasions when these patients do report a parallel increase in sexual intensity, their primary issue isn't biological or existential. Rather, it is about safety. At the deepest level of our psyches, the real reason some of us get turned on by disasters is because disasters make us unconsciously feel safe to be sexual.

In this, those who find themselves especially erotically excited after a tragedy are no different than the rest of us. The human psyche is wired such that sexual desire can only be experienced in a safe context. Safety doesn't only refer to the absence of external dangers, like terrorism, but freedom from internal dangers like guilt, worry, shame, rejection and helplessness. People can't get turned on if they're worried about hurting their partners or feel overly responsible for satisfying them, if they're guilty about being selfish or feel shame, depression or helplessness. As an example, one female patient of mine can only get aroused if she has sex in the dark because the darkness helps her unconsciously feel safe from feelings of shame. A male patient likes to be on the bottom during sex because the image of a strong woman dominating him reassures him against his fears of hurting women. And yet another patient is aroused by taking on the dominant role in the bedroom because it reverses chronic feelings of helplessness. It is only when we feel safe -- albeit momentarily -- from these dangers that we can become sexually aroused.

A patient once told me about an incident in which he and his wife were held up at gunpoint, but managed to escape. This man had struggled on and off his whole life with depression, and his relationship with his wife was secure but rather flat and tepid. That night of the mugging, however, he told me that he was a veritable sexual tiger. When they finally came home, not only was he not depressed, he felt strangely excited. His wife looked different to him, he said. He noticed her body and was aroused by it. "I jumped her," he told me. "She was into it too. We did it on the living room floor. I can't tell you how unusual it was. It was like I almost felt reborn and somehow sex was a part of it."

As we went on to discover, on a certain level, my patient felt that escaping the threat of serious injury or death gave him a reprieve from the self-hatred that lay at the core of his depression. On a symbolic level, surviving a danger felt like he was given permission to be alive, that Fate was saying that he didn't deserve to suffer or die. Momentarily freed of his guilt and self-hatred, he could feel safe enough to get sexually aroused. Often people in his position will believe the adrenaline rush of fear is what is arousing them. But, in all of these cases, what we find is that it is the very surviving of the danger that is so arousing -- not, in fact, the danger itself.

Another patient recounted for me her narrow escape from a building that collapsed during the 1994 earthquake in Los Angeles. The next day, she promptly picked up a man in a bar, took him home and had sex with him, something that she rarely, if ever, did. She told me that normally she would only have sex with a man if she felt that there was some emotional commitment. This time, she wanted to, as she put it, "just get laid." She didn't want affection, she said, just sex. "I felt like men must feel all the time," she told me.

The carnage of the earthquake and the disaster mentality that resulted, we uncovered, made her feel as if the real world's "business as usual" approach to life, and sex, had been suspended. The old rules didn't apply, it seemed; somehow she no longer had to be as hyper-responsible, guilty and careful as she had always been. The psychological and physical dislocations of the earthquake made it safe enough for this woman to temporarily feel safe about being aggressive and hedonistic in the erotic arena. When external prohibitions weaken, we unconsciously feel as if we are being given permission to relax our internal ones. Many of these internal prohibitions, of course, involve our sexual desires.

In our normal day-to-day lives, when it comes to sex, too much familiarity can function like a cold shower in a romantic relationship. Emotional boundaries become fuzzy as people come to know each other inside out, the capacity to maintain a high state of sexual interest is dampened and it is no longer as easy to maintain the sense of surprise and separation that healthy passion requires. Catastrophes change all of this. Nothing is familiar. Everything has changed. People encounter each other as if strangers, and this newfound strangeness is what makes it safer to break taboos, take risks and negate feelings of guilt, shame or rejection. When the "dangers" of familiarity and intimacy temporarily lessen, erotic desire can safely -- and readily -- break through.

At the same time, when disasters loosen our social bonds, threatening not only the familiar, but life itself, the danger of isolation and loss increases. Sexual excitement serves to reconnect people and counteract these dangers, however momentarily. So, when we see lovers reach out to each other for comfort in these post-traumatic times, we witness the extreme, fundamental importance of safety in sexual arousal. While the threat of loss leads to a heightened longing for sexual connection, the loss of familiarity and the disruption of ordinary expectations and rules creates the space that makes such connections more possible. People invariably find ways to weave the many aspects of surviving a tragedy into the safety net necessary for sexual pleasure to flourish.

Recently, my patient Bob came in my office having just arrived home from New York City where he had helped to bury a colleague who had worked on the 75th floor of World Trade Center One. He described the devastation he had witnessed at Ground Zero, the intense sorrow he had experienced at his friend's funeral and admitted to feelings of guilt about the fact that his friend had died and not him. Eventually, he confessed to me, he had also had a bizarre -- and, to his mind, shameful -- reaction when he had offered his condolences to his friend's grief-stricken wife. He had wanted to comfort her, but, at the same time, he had felt the stirrings of sexual excitement. What Bob wondered now was if something in her very helplessness and dependency had turned him on. "If that's the case," Bob opined, "I'm a pervert."

"You aren't a pervert," I explained to him. "Your intense need for comfort and her intense vulnerability in this situation turned you on because it triggered your very real need to be someone's savior. You had a fantasy of rescuing another person through a sexual connection, and the fantasy of saving someone in this way reassures you that you aren't a bad person for having survived, that you can, in fact, heal others, rather than be overwhelmed by their sadness." Bob seemed to visibly relax. "So, then, I'm not a pervert?" Bob asked. "No," I told him, just human."

Dr. Michael Bader is a psychologist in private practice and a contributor to Tikkun magazine. His book, "Arousal: The Secret Logic of Sexual Fantasies," will be published in December by St. Martin's Press.

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